河北省重症肺炎患儿非细菌性呼吸道病原学研究

Study on the non-bacterial respiratory pathogens in children with severe pneumonia in Hebei province

目的了解河北地区儿童重症肺炎非细菌性呼吸道病原的感染分布情况及流行病学特点,为临床早期针对性治疗及病原体诊断提供参考依据。方法采集2016至2017年重症医学科住院的重症肺炎患儿深部气道吸取物标本2481例,并采用多重RT-PCR方法检测甲型流感病毒(InfA)、甲型流感病毒H1N1(09H1)、季节性H3N2病毒(H3)、乙型流感病毒(InfB)、腺病毒(HADV)、博卡病毒(Boca)、鼻病毒(HRV)、副流感病毒(HPIV)、衣原体(Ch)、偏肺病毒(HMPV)、肺炎支原体(Mp)、冠状病毒(HCOV)和呼吸道合胞病毒(HRSV),分析其分布情况及流行病学特点。结果2481例标本中病毒总检出例数为1944例(78.36%),其中HRV检出率最高,其次为HRSV和HPIV;非典型病原体216例(8.70%)。混合感染546例(21.95%),其中双重感染最为常见。HRSV秋冬季检出率较高(P<0.05),Boca在秋季检出率最高(P<0.05),HPIV夏秋季检出率较高(P<0.05),HADV春夏季检出率较高(P<0.05),FluA、FluB和HMPV春季检出率明显增高(P<0.05),非典型病原体的感染高峰出现在秋季(P<0.05)。儿童重症肺炎主要发生在婴幼儿时期,呼吸道病毒在3岁及以下婴幼儿中检出率高(P<0.05),而Mp在4岁及以上患儿中检出率较高(P<0.05),混合感染则好发于1~3岁幼儿(P<0.05)。结论非细菌性病原体是河北地区儿童重症肺炎的重要病因,以HRV、HRSV、HPIV和Mp比较常见,混合感染率较高,且不同病原体的季节及年龄分布规律不同。

Objective To investigate the distribution and epidemiological characteristics of non-bacterial respiratory pathogens in the children with severe pneumonia in order to provide evidence for early clinical treatment and pathogen diagnosis.Methods A total of 2481 deep airway aspirates specimens in children with severe pneumonia who were hospitalized and treated in our hospital from January 2016 to December 2017 were collected.The Influenza A virus(InfA),Influenza A virus H1N1(09H1),Influenza A virus H3N2(H3),Influenza B virus(InfB),Human adenovirus(HADV),Bocavirus(Boca),Human rhinovirus(HRV),Parainfluenza virus(HPIV),Chlamydia(Ch),Human metapneumovirus(HMPV),Mycoplasma pneumonia(Mp),Human coronavims(HCOV)and Respiratory syncytial virus(HRSV)were detected by multiple reverse transcription PCR assay(multiple RT-PCR).Moreover the distribution and epidemiological characteristics of those pathogens were analyzed.Results Among the 2481 specimens,the virus pathogens were detected in 1944 specimens(78.36%),of which,the detection rate of HRV was the highest,followed by HRSV and HPIV,there were 216 cases(8.70%)of atypical pathogens,and there were 546 cases(21.95%)of mixed infection,of which,the double-infection was the most common.The positive rate of HRSV was higher in autumn and winter,the positive rate of Boca was the highest in autumn,the positive rate of HPIV was higher in summer and autumn,and the positive rate of HADV was higher in spring and summer,and the positive rates of HMPV,FluA and FluB were higher in spring,and the detection peak of atypical pathogens appeared in autumn(P<0.05).In addition the severe pneumonia mainly occurred in infants,and the detection rate of respirovirus was higher in children≤3 years of age(P<0.05),however,the detection rate of Mp was higher in children≥4 years of age.And mixed infection was more common in children with age range being 1~3yr.Conclusion The non-bacterial pathogens are important etiology of severe pneumonia in children in Hebei Province,and the HRV,HRSV,HPIV and Mp are common pathogens,and the polyinfection rate is higher.moreover,the different pathogens show seasonal and age differences.